Yesterday, November 17, was World Prematurity Day. According to the March of Dimes, complications of prematurity are the number one cause of death of young children, resulting in about 1.1 million deaths. In honor of World Prematurity Day, I would like to present some of the newest research on prematurity in the October 2015 Grey Journal.
The October Grey Journal features this research from a tremendous collaboration between no less than 25 different hospitals who joined together with the help of the NIH to measure maternal outcomes after very early preterm deliveries, 23 to 33 weeks. Dr Reddy and her team of co-authors undertook the tremendous work of extracting data on a random one third of all deliveries at these 25 hospitals over 3 years, totaling over 115,000 deliveries. Out of this large cohort, they selected mothers with preterm births from 23 to 33 weeks gestation with nonanomalous singleton pregnancies. They excluded women with nonreassuring fetal status, cord prolapse, placenta previa, placenta accreta, placental abruption, and severe and unstable maternal conditions (such as cardiopulmonary collapse, acute respiratory distress syndrome, seizures).
Of the 2,659 women remaining in the study, the researchers found that maternal complications including hemorrhage, infection, ICU admission, and death were higher for women who underwent a classical cesarean delivery. The complication rate for a classical cesarean delivery was 23%, followed by 12% complication rate for low transverse cesarean delivery, then 10% for low vertical cesarean delivery. The lowest complication rate was 3.5% for vaginal delivery. The difference in complications between classical and low transverse or low vertical incisions was not significant. The authors did adjust for possible confounders such as maternal age and BMI.
With regard to the risk associated with gestational age, the earliest preterm births, those from 23 to 27 weeks, were associated with the most maternal complications, with a complication rate of 11.5%. In contrast, the overall complication rate was 8.6%.
This interesting study draws attention to the fact that preterm births are also risky for mothers, not only infants, and reminds providers to be prepared for maternal complications after preterm deliveries.